Treatment Options for Aortic Valve Stenosis: Developing an Algorithm for Best Practice between TAVR and Surgical AVR

This Doctor of Nursing Practice Scholarly Project addressed the problem of a lack of guidelines about the surgical options for the surgical treatment of aortic valve stenosis and the impact this has on a patient's ability to make an informed decision and their outcomes. The purpose of this project was to create a surgical algorithm for outlining the evidenced based treatment options for aortic valve stenosis. Current treatment options include: Medical management, surgical aortic valve replacement (SAVR), and the trans-femoral, trans-apical, and trans-aortic transcatheter aortic valve replacement (TAVR) procedures. Based on surgical risk, symptom severity, and physiologic criteria the algorithm will help guide decision making for the most appropriate surgical intervention. There are currently no guidelines available for the SAVR verses and between the three approaches of the TAVR. The procedure selection can be influenced by provider and patient preference and may lead to the patient receiving an inappropriate procedure. There is also resistance among surgeons and the surgical team to utilize the transcatheter aortic valve replacement due to lack of evidence based research. The main objective of this project is to create an algorithm to assist surgeons and patients in the decision regarding the optimal surgical procedure. Research was utilized for development of this algorithm and surgeons will be able to use the algorithm to choose treatment options based on the presenting characteristics of a patient. To create the algorithm, quality of life, physiologic factors, complications, risk factors, procedure recommendations, and cost-effectiveness of both the SAVR and TAVR were examined. The current research was synthesized and presented to content experts and the committee for approval. The algorithm was presented to the Cardiothoracic Surgical team for adoption into practice. A presentation of the research and algorithm was presented to the cardiothoracic surgical department. Finally, a manuscript on the topic was submitted for publication. Quality of life significantly changed from baseline in both SAVR and TAVR and the TAVR is considered a good option for nonsurgical patients. Cost is similar among all procedures when considering surgery, hospital stay, and rehabilitation. Stroke is the most common complication in all procedures. Overall mortality and repeat hospitalizations are equal between all interventions. Aortic valve stenosis is a common problem among the geriatric population that has left many patients with a poor quality of life. There are currently no guidelines for surgical intervention, which has lead to under-utilization of the Transcatheter AVR for high-risk patients. Developing a surgical intervention algorithm for aortic valve stenosis will help patients receive the best aortic valve procedure for them.